Section
III. GIVE PROPER FIRST AID FOR CHEST AND ABDOMINAL WOUNDS AND BURN INJURIES
3-9. Chest Wounds (081-831-1026)Chest
injuries may be caused by accidents, bullet or missile wounds, stab wounds, or
falls. These injuries can be serious and may cause death quickly if proper treatment
is not given. A casualty with a chest injury may complain of pain in the chest
or shoulder area; he may have difficulty with his breathing. His chest may not
rise normally when he breathes. The injury may cause the casualty to cough up
blood and to have a rapid or a weak heartbeat. A casualty with an open chest wound
has a punctured chest wall. The sucking sound heard when he breathes is caused
by air leaking into his chest cavity. This particular type of wound is dangerous
and will collapse the injured lung (Figure 3-21). Breathing becomes difficult
for the casualty because the wound is open. The soldier’s life may depend upon
how quickly you make the wound airtight.

3-10.
Chest Wound(s) Procedure (081-831-1026)
* a. Evaluate the Casualty (081-831-1000). Be prepared to perform lifesaving
measures. The basic lifesaving measures may include clearing the airway, rescue
breathing, treatment for shock, and/or bleeding control.b. Expose the Wound.
If appropriate, cut or remove the casualty’s clothing to expose the entire area
of the wound. Remember, DO NOT remove clothing that is stuck to the wound because
additional injury may result. DO NOT attempt to clean the wound.

NOTEExamine
the casualty to see if there is an entry and/or exit wound. If there are two wounds
(entry, exit), perform the same procedure for both wounds. Treat the more serious
(heavier bleeding, larger) wound first. It may be necessary to improvise a dressing
for the second wound by using strips of cloth, such as a torn T-shirt, or whatever
material is available. Also, listen for sucking sounds to determine if the chest
wall is punctured.

CAUTIONIf
there is an object extending from (impaled in) the wound, DO NOT remove the object.
Apply a dressing around the object and use additional improvised bulky materials/dressings
(use the cleanest materials available) to buildup the area around the object.
Apply a supporting bandage over the bulky materials to hold them in place.

CAUTION
(081-831-1026)DO NOT REMOVE protective clothing in a chemical environment.
Apply dressings over the protective clothing.

c.
Open the Casualty’s Field Dressing Plastic Wrapper. The plastic wrapper is
used with the field dressing to create an airtight seal. If a plastic wrapper
is not available, or if an additional wound needs to be treated; cellophane, foil,
the casualty’s poncho, or similar material may be used. The covering should be
wide enough to extend 2 inches or more beyond the edges of the wound in all directions.(1)
Tear open one end of the casualty’s plastic wrapper covering the field dressing.
Be careful not to destroy the wrapper and DO NOT touch the inside of the wrapper.(2)
Remove the inner packet (field dressing).(3) Complete tearing open the empty
plastic wrapper using as much of the wrapper as possible to create a flat surface.d.
Place the Wrapper Over the Wound (081-831-1026). Place the inside surface
of the plastic wrapper directly over the wound when the casualty exhales
and hold it in place (Figure 3-22). The casualty may hold the plastic wrapper
in place if he is able.e.
Apply the Dressing to the Wound (081-831-1026). (1) Use your free hand and
shake open the field dressing (Figure 3-23)(2)
Place the white side of the dressing on the plastic wrapper covering the wound
(Figure 3-24).

NOTE
(081-831-1026)Use the casualty’s field dressing, not your own.

(3)
Have the casualty breathe normally.(4) While maintaining pressure on the dressing,
grasp one tail of the field dressing with the other hand and wrap it around the
casualty’s back.(5) Wrap the other tail in the opposite direction, bringing
both tails over the dressing (Figure 3-25).(6)
Tie the tails into a nonslip knot in the center of the dressing after
the casualty exhales and before he inhales. This will aid in maintaining
pressure on the bandage after it has been tied (Figure 3-26). Tie the dressing
firmly enough to secure the dressing without interfering with the casualty’s breathing.

NOTE
(081-831-1026)When practical, apply direct manual pressure over the
dressing for 5 to 10 minutes to help control the bleeding.

f.
Position the Casualty (081-831-1026). Position the casualty on his injured
side or in a sitting position, whichever makes breathing easier (Figure 3-27).g.
Seek Medical Aid. Contact medical personnel.

*WARNINGEven
if an airtight dressing has been placed properly, air may still enter the chest
cavity without having means to escape. This causes a life-threatening condition
called tension pneumothorax. If the casualty’s condition (for example, difficulty
breathing, shortness of breath, restlessness, or grayness of skin in a dark-skinned
individual [or blueness in an individual with light skin]) worsens after placing
the dressing, quickly lift or remove, then replace the airtight dressing.

3-11.
Abdominal WoundsThe
most serious abdominal wound is one in which an object penetrates the abdominal
wall and pierces internal organs or large blood vessels. In these instances, bleeding
may be severe and death can occur rapidly.

3-12.
Abdominal Wound(s) Procedure (081-831-1025)a.
Evaluate the Casualty. Be prepared to perform basic lifesaving measures. It
is necessary to check for both entry and exit wounds. If there are two wounds
(entry and exit), treat the wound that appears more serious first (for example,
the heavier bleeding, protruding organs, larger wound, and so forth). It may be
necessary to improvise dressings for the second wound by using strips of cloth,
a T-shirt, or the cleanest material available.b. Position the Casualty.
Place and maintain the casualty on his back with his knees in an upright (flexed)
position (Figure 3-28). The knees-up position helps relieve pain, assists in the
treatment of shock, prevents further exposure of the bowel (intestines) or abdominal
organs, and helps relieve abdominal pressure by allowing the abdominal muscles
to relax.c.
Expose the Wound.(1) Remove the casualty’s loose clothing to expose the
wound. However, DO NOT attempt to remove clothing that is stuck to the wound;
it may cause further injury. Thus, remove any loose clothing from the wound but
leave in place the clothing that is stuck.

CAUTION
(081-831-1000 and 081-831-1025)DO NOT REMOVE protective clothing in
a chemical environment. Apply dressings over the protective clothing.

(2)
Gently pick up any organs which may be on the ground Do this with a clean, dry
dressing or with the cleanest available material, Place the organs on top of the
casualty’s abdomen (Figure 3-29).

NOTE
(081-831-1025) DO NOT probe, clean, or try to remove any foreign
object from the abdomen. DO NOT touch with bare hands any exposed organs.
DO NOT push organs back inside the body.

d.
Apply the Field Dressing. Use the casualty’s field dressing not your own.
If the field dressing is not large enough to cover the entire wound, the plastic
wrapper from the dressing may be used to cover the wound first (placing the field
dressing on top). Open the plastic wrapper carefully without touching the inner
surface, if possible. If necessary other improvised dressings may be made from
clothing, blankets, or the cleanest materials available because the field dressing
and/or wrapper may not be large enough to cover the entire wound.

WARNINGIf
there is an object extending from the wound, DO NOT remove it. Place as much of
the wrapper over the wound as possible without dislodging or moving the object.
DO NOT place the wrapper over the object.

(1)
Grasp the tails in both hands.(2) Hold the dressing with the white, or cleanest,
side down directly over the wound.(3) Pull the dressing open and place it
directly over the wound (Figure 3-30). If the casualty is able, he may hold the
dressing in place.(4)
Hold the dressing in place with one hand and use the other hand to wrap one of
the tails around the body.(5) Wrap the other tail in the opposite direction
until the dressing is completely covered. Leave enough of the tail for a knot.(6)
Loosely tie the tails with a nonslip knot at the casualty’s side (Figure 3-31).

WARNINGWhen
dressing is applied, DO NOT put pressure on the wound or exposed internal parts,
because pressure could cause further injury (vomiting, ruptured intestines, and
so forth). Therefore, tie the dressing ties (tails) loosely at casualty’s side,
not directly over the dressing.

(7)
Tie the dressing firmly enough to prevent slipping without applying pressure to
the-wound-site (Figure 3-32).Field
dressings can be covered with improvised reinforcement material (cravats, strips
of torn T-shirt, or other cloth), if available, for additional support and protection.
Tie improvised bandage on the opposite side of the dressing ties firmly enough
to prevent slipping but without applying additional pressure to the wound.

CAUTION
(081-831-1025)DO NOT give casualties with abdominal wounds food nor
water (moistening the lips is allowed).

e.
Seek Medical Aid. Notify medical personnel.

3-13. Burn InjuriesBurns
often cause extreme pain, scarring, or even death. Proper treatment will minimize
further injury of the burned area. Before administering the proper first aid,
you must be able to recognize the type of burn to be treated. There are four types
of burns: (1) thermal burns caused by fire, hot objects, hot liquids, and gases
or by nuclear blast or fire ball; (2) electrical burns caused by electrical wires,
current, or lightning; (3) chemical burns caused by contact with wet or dry chemicals
or white phosphorus (WP)—from marking rounds and grenades; and (4) laser burns.

3-14.
First Aid for Burns (081-831-1007)a.
Eliminate the Source of the Burn. The source of the burn must be eliminated
before any evaluation or treatment of the casualty can occur.(1) Remove the
casualty quickly and cover the thermal burn with any large nonsynthetic
material, such as a field jacket. Roll the casualty on the ground to smother (put
out) the flames (Figure 3-33).

CAUTIONSynthetic
materials, such as nylon, may melt and cause further injury.

(2)
Remove the electrical burn casualty from the electrical source by turning
off the electrical current. DO NOT attempt to turn off the electricity if the
source is not close by. Speed is critical, so DO NOT waste unnecessary time. If
the electricity cannot be turned off, wrap any nonconductive material (dry
rope, dry clothing, dry wood, and so forth) around the casualty’s
back and shoulders and drag the casualty away from the electrical source (Figure
3-34). DO NOT make body-to-body contact with the casualty or touch any wires because
you could also become an electrical burn casualty.

(3)
Remove the chemical from the burned casualty. Remove liquid
chemicals by flushing with as much water as possible. If water is not available,
use any nonflammable fluid to flush chemicals off the casualty. Remove dry
chemicals by brushing off loose particles (DO NOT use the bare surface of your
hand because you could become a chemical burn casualty) and then flush with large
amounts of water, if available. If large amounts of water are not available,
then NO water should be applied because small amounts of water applied to a dry
chemical burn may cause a chemical reaction. When white phosphorous strikes the
skin, smother with water, a wet cloth, or wet mud. Keep white phosphorous covered
with a wet material to exclude air which will prevent the particles from
burning.

WARNINGSmall
amounts of water applied to a dry chemical burn may cause a chemical reaction,
transforming the dry chemical into an active burning substance.

(4)
Remove the laser burn casualty from the source. (NOTE: Lasers produce a
narrow amplified beam of light. The word laser means Light Amplification by Stimulated
Emission of Radiation and sources include range finders, weapons/guidance, communication
systems, and weapons simulations such as MILES.) When removing the casualty from
the laser beam source, be careful not to enter the beam or you may become a casualty.
Never look directly at the beam source and if possible, wear appropriate eye protection.

NOTEAfter
the casualty is removed from the source of the burn, he should be evaluated for
conditions requiring basic lifesaving measures (Evaluate the Casualty).

b.
Expose the Burn. Cut and gently lift away any clothing covering the burned
area, without pulling clothing over the burns. Leave in place any clothing that
is stuck to the burns. If the casualty’s hands or wrists have been burned, remove
jewelry if possible without causing further injury (rings, watches, and so forth)
and place in his pockets. This prevents the necessity to cut off jewelry since
swelling usually occurs as a result of a burn.

CAUTION
(081-831-1007) DO NOT lift or cut away clothing if in a chemical
environment. Apply the dressing directly over the casualty’s protective clothing.
DO NOT attempt to decontaminate skin where blisters have formed.

c.
Apply a Field Dressing to the Burn.(1) Grasp the tails of the casualty’s
dressing in both hands.(2) Hold the dressing directly over the wound with
the white (sterile) side down, pull the dressing open, and place it directly over
the wound. If the casualty is able, he may hold the dressing in place.(3)
Hold the dressing in place with one hand and use the other hand to wrap one of
the tails around the limbs or the body.(4) Wrap the other tail in the opposite
direction until the dressing is completely covered.(5) Tie the tails into
a knot over the outer edge of the dressing. The dressing should be applied lightly
over the burn. Ensure that dressing is applied firmly enough to prevent it from
slipping.

NOTEUse
the cleanest improvised dressing material available if a field dressing is not
available or if it is not large enough for the entire wound.

d.
Take the Following Precautions (081-831-1007): DO NOT place the
dressing over the face or genital area. DO NOT break the blisters.
DO NOT apply grease or ointments to the burns.For electrical burns, check
for both an entry and exit burn from the passage of electricity through the body.
Exit burns may appear on any area of the body despite location of entry burn.
For burns caused by wet or dry chemicals, flush the burns with large amounts of
water and cover with a dry dressing. For burns caused by white phosphorus
(WP), flush the area with water, then cover with a wet material, dressing, or
mud to exclude the air and keep the WP particles from burning. For laser
burns, apply a field dressing. If the casualty is conscious and not
nauseated, give him small amounts of water.e. Seek Medical Aid. Notify
medical personnel.